Surgical steps for right laparoscopic D3 lymphadenectomy in a patient with a giant duodenal diverticulum

Jeri-McFarlane, Sebastián; García-Granero, Álvaro; Gil-Catalán, Alejandro; Romaguera, Vicent Primo; Pellino, Gianluca; Ochogavia-Seguí, Aina; Blasco-Cerda, A.; Gamundi-Cuesta, Margarita; González‐Argente, Francesc Xavier

doi:10.1007/s10151-020-02377-5

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“…In recent years, the concept of CME with dissection adhering to embryological planes and central vascular ligation (CVL) has also been adopted to colonic resection [ 5 , 25 ]. While data exist describing an increased disease-free survival (DFS) in patients who have undergone right colectomy using CME [ 26 , 27 ], little is known about the perioperative morbidity and mortality associated with CME/CVL [ 28 ]. Hohenberg et al [ 8 ] proposed a nodal dissection even more extended than the standard D3 proposed by Japanese surgical societies, known as CVL.…”

Section: Discussionmentioning

confidence: 99%

Central vascular ligation and mesentery based abdominal surgery

et al. 2021

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In the nineteenth century the idea of a correct surgical approach in oncologic surgery moved towards a good lymphadenectomy. In colon cancer the segment is removed with adjacent mesentery, in gastric cancer or pancreatic cancer a good oncologic resection is obtained with adequate lymphadenectomy. Many guidelines propose a minimal lymph node count that the surgeon must obtain. Therefore, it is essential to understand the adequate extent of lymphadenectomy to be performed in cancer surgery. In this review of the current literature, the focus is on “central vascular ligation”, understood as radical lymphadenectomy in upper and lower gastrointestinal cancer, the evolution of this approach during the years and the improvement of laparoscopic techniques. For what concerns laparoscopic surgery, the main goal is to minimize post-operative trauma introducing the “less is more” concept whilst preserving attention for oncological outcomes. This review will demonstrate the importance of a scientifically based standardization of oncologic gastrointestinal surgery, especially in relation to the expansion of minimally invasive surgery and underlines the importance to further investigate through new randomized trials the role of extended lymphadenectomy in the new era of a multimodal approach, and most importantly, an era where minimally invasive techniques and the idea of “less is more” are becoming the standard thought for the surgical approach.

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